Accessing care with mental illness - the role of stigma

Stigma is one of the most significant barriers to receiving appropriate mental health care.

Improvement: 70% Canadians believe attitudes about mental health issues have changed for the better compared to five years ago.

It remains a barrier: It’s implications for care is more significant for those with some types of illnesses.

The Mental Health Commission says that patients with certain disorders, such as personality disorders, tend to be particularly rejected by healthcare staff and are often felt to be difficult, manipulative’ thus less likely to be perceived as deserving of care.

Canada is one of the most socio-economically and ethnically diverse country in the world, with a large immigrant population. Access to care coast to coast is critical, but there are ongoing inequalities based on geography, rural/urban divides, socio-economic status, and indigeneity.

Income, Poverty, and Social Status

The Mental Health Commission of Canada details a strong connection between ‘low income levels, income inequality, financial insecurity, poverty and mental health problems and illness’.

CMHA: Individuals suffering from mental illnesses often live in chronic poverty.

Stigma, and discrimination in low income communities prevents individuals from seeking help and from securing long term employment.

CMHA states: A lack of secure employment affects one’s ability to earn an adequate income thus implicating them further into a mental ill state.

Mental illness is present in all socioeconomic statuses. Living in poverty does not mean an individual has a mental illness, and vice versa.

Immigrant and Migrant Communities

Canadians moving from rural areas to urban cities, or indigenous peoples moving from their reserves, or new Canadians immigrating to Canada face challenges with these changes which can affect mental health and access to care.

The mental health of an immigrant or refugee Canadians is affected perceived racial discrimination, migration and language difficulties

Services for immigrant women exist, but it may be difficult to access.

Access has been overlooked in immigrant women due to the barriers

Access to services is most likely poor in quality, if it is received.

The immigrant’s legal status is related to the access and quality of help.

A problem for immigrant groups is the loss of social support networks after moving. It takes energy and time to reconstitute these networks and though there is a history of immigrant groups organizing to provide support, it may be limited in comparison to what they left behind

Language Barriers

Statcan reports that immigrants to Canada who are not fluent in either national language may experience isolation resulting in higher rates of depression and alcohol dependence.

There are language barriers in explaining and detailing one’s mental health to medical practitioners. Practitioners are unable to deliver culturally and contextually sound treatments and impose their own culture and biases.

Immigrant communities are often isolating of individuals seeking mental health support

Individuals with mental illnesses at times ostracized, or ridiculed. This creates barriers in individuals seeking out diagnosis, and support to better their mental health.

Rural Communities

CMHA: ‘individuals living in rural and northern areas have higher than average rates of major depressive disorder.’

Rural Canada has ‘barriers to accessing primary health care and psychiatrists beyond the limitations of being in an underserved area.’

Rural communities have low density, with individuals spread across vast areas. Per capita funding for health care may result in inadequate funding for need and the costs associated with large geographic areas.

Residents of rural, and northern communities are often forced to urban hubs to receive access to services. Territorial mental health support leaves individuals to travel for hours for unguaranteed support despite Northwest Territories having the highest rate of suicide in Canada.

Indigenous Communities

Almost every Indigenous person has been affected by suicide in some way, whether it’s a friend, family member, classmate, or they’ve experienced those thoughts themselves.

States of emergency declared in these communities, due to lack of resources and counsellors.

Mental Health is underfunded in Indigenous communities

Youth in many communities don’t have enough spaces of safe people available to safely talk about suicide in a constructive way.

Statistics Canada: the suicide rate “among children and teens in the Inuit homelands was 30 times that of youth in the rest of Canada (between 2004 to 2008).”

The United Nations Declaration on the Rights of Indigenous People: “Indigenous individuals have an equal right to the enjoyment of the highest attainable standard of physical and mental health. States shall take the necessary steps with a view to achieving progressively the full realization of this right.”

Treatment Centres/Support for Addictions/ Trauma Informed Approaches

DEFINITION

Trauma

Trauma can be caused by an overwhelming negative event that creates a lasting impact on the victim’s mental and emotional stability. While some sources of trauma is physically violent, other forms of trauma are psychological.

DEFINITION

Trauma Informed Approaches

A framework that is responsive to the impact of trauma, emphasizing physical, mental, and emotional safety for both service providers and survivors. It creates opportunities for survivors to rebuild a sense of control and empowerment.

In 2012, StatsCan reported individuals diagnosed with mental illness and substance use were more likely to seek and receive support than individuals with one diagnosis.

39% of individuals with concurrent diagnoses who sought consultation with a health care provider reported that they “had an unmet or only partially met need for mental health care.”

Overall, many Canadians with mental health and substance use disorders lack access to supports and resources, with only a small proportion of individuals with substance use issues accessing “evidence-informed treatment.”

DEFINITION

Evidence informed treatment

A It means using evidence to identify the potential benefits, harms and costs of any intervention and also acknowledging that what works in one context may not be appropriate or feasible in another. Evidence informed practice brings together local experience and expertise with the best available evidence from research.

A Mental Health and Addictions Report: examined examined the current quality of care and services Ontarians are receiving for mental illness and addictions, and found “substantial differences in access to care due to gender, age, income, immigration status, or whether a person lives in a rural or urban area.”

Realizes the widespread impact of trauma and understands potential paths for recovery;

Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system;

Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and

Seeks to actively resist re-traumatization.

DEFINITION

Re-Traumatization

Relapse into a state of trauma, triggered by subsequent events.

Who is doing something now?

When it comes to access to care, there are several key decision makers you can engage with:

Provincial, territorial, and federal Ministers of Health

Provincial and territorial Ministers of Education have an influence

Ministers responsible for Indigenous services or relations have specific responsibilities related to access to care for Indigenous Canadians

Mental Health Commission of Canada

Municipal governments

There are several elected representatives who have been very public about their own mental health struggles, including Celina Caesar-Chavannes (MP for Whitby) and Lisa MacLeod (MPP for Nepean—Carleton). They make great allies and if they are your MP or MPP - lucky you!